Unintended Consequences of SCOTUS Abortion Decision for Patients With Rheumatic Diseases
Authors: Megan E.B. Clowse, Kenneth G. Saag
Journal: Annals of Internal Medicine (2022)

Ideas and OpinionsSeptember 2022Unintended Consequences of SCOTUS Abortion Decision for Patients With Rheumatic DiseasesMegan E.B. Clowse, MD, MPH and Kenneth G. Saag, MD, MScMegan E.B. Clowse, MD, MPHDuke University School of Medicine, Durham, North Carolina (M.E.C.) and Kenneth G. Saag, MD, MScThe University of Alabama at Birmingham, Birmingham, Alabama (K.G.S.).Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M22-2246 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The recent ruling by the Supreme Court of the United States (SCOTUS) on Dobbs v. Jackson raises concerns for patients with rheumatic disease and their clinicians. First is a concern about access to medically indicated abortion that has been indicated because of teratogen exposure or active rheumatic disease. Second is a worry about access to necessary medications that are teratogenic. Third is a concern about laws that interfere with patient–clinician discussions about reproductive issues.Pregnancy can be difficult for patients with rheumatic disease. During pregnancy, some patients with serious inflammatory disease face threats to their joints, organs, and life, and ...References1. Götestam Skorpen C, Hoeltzenbein M, Tincani A, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016;75:795-810. [PMID: 26888948] doi:10.1136/annrheumdis-2015-208840 CrossrefMedlineGoogle Scholar2. Sarayani A, Albogami Y, Thai TN, et al. Prenatal exposure to teratogenic medications in the era of Risk Evaluation and Mitigation Strategies. Am J Obstet Gynecol. 2022;227:263.e1-263.e38. [PMID: 35032444] doi:10.1016/j.ajog.2022.01.004 CrossrefMedlineGoogle Scholar3. Birru Talabi M, Eudy AM, Jayasundara M, et al. Tough choices: exploring medication decision-making during pregnancy and lactation among women with inflammatory arthritis. ACR Open Rheumatol. 2021;3:475-483. [PMID: 34114738] doi:10.1002/acr2.11240 CrossrefMedlineGoogle Scholar4. Marder W, Knight JS, Kaplan MJ, et al. Placental histology and neutrophil extracellular traps in lupus and pre-eclampsia pregnancies. Lupus Sci Med. 2016;3:e000134. [PMID: 27158525] doi:10.1136/lupus-2015-000134 CrossrefMedlineGoogle Scholar5. Clowse ME, Magder LS, Witter F, et al. The impact of increased lupus activity on obstetric outcomes. Arthritis Rheum. 2005;52:514-21. [PMID: 15692988] CrossrefMedlineGoogle Scholar6. GoodRx. Accessed at www.goodrx.com/ on 21 July 2022. Google Scholar7. Hahn BH, McMahon MA, Wilkinson A, et al; American College of Rheumatology. American College of Rheumatology guidelines for screening, treatment, and management of lupus nephritis. Arthritis Care Res (Hoboken). 2012;64:797-808. [PMID: 22556106] doi:10.1002/acr.21664 CrossrefMedlineGoogle Scholar8. Horowitch R. State abortion bans prevent women from getting essential medication. Reuters. Accessed at www.reuters.com/world/us/state-abortion-bans-prevent-women-getting-essential-medication-2022-07-14/ on 26 July 2022. Google Scholar9. Guttmacher Institute. State laws and policies: an overview of abortion laws. Accessed at www.guttmacher.org/state-policy/explore/overview-abortion-laws on 21 July 2022. Google Scholar Author, Article, and Disclosure InformationAffiliations: Duke University School of Medicine, Durham, North Carolina (M.E.C.)The University of Alabama at Birmingham, Birmingham, Alabama (K.G.S.).Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-2246.Corresponding Author: Megan E.B. Clowse, MD, MPH, Box 3535, Trent Drive, Durham NC 27710; e-mail, megan.[email protected]edu.Author Contributions: Conception and design: M.E. Clowse, K.G. Saag.Analysis and interpretation of the data: M.E. Clowse, K.G. Saag.Drafting of the article: M.E. Clowse, K.G. Saag.Critical revision for important intellectual content: M.E. Clowse, K.G. Saag.Provision of study materials or patients: K.G. Saag.Final approval of the article: M.E. Clowse, K.G. Saag.Administrative, technical, or logistic support: M.E. Clowse, K.G. Saag.Collection and assembly of data: M.E. Clowse, K.G. Saag.This article was published at Annals.org on 9 August 2022. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byWhat Follows From State-Mandated Pregnancy?Jake Earl, PhD and Caitlin J. Cain, MD September 2022Volume 175, Issue 9Page: 1328-1329KeywordsContraceptivesLupus nephritisMethotrexatePregnancyRheumatoid arthritisRheumatologyTermination of pregnancy ePublished: 9 August 2022 Issue Published: September 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...